This document discusses various thyroid conditions including hyperthyroidism, hypothyroidism, and thyroiditis. It outlines the common causes, symptoms, signs, and treatments for hyperthyroidism such as Graves' disease. It also discusses the causes, symptoms, signs, lab investigations, and treatment of hypothyroidism. It covers the different types of thyroiditis including acute, subacute, and chronic forms such as Hashimoto's thyroiditis.

2. Aspects That Will Be Addressed
Hyperthyroidism
Hypothyroidism
Thyroiditis

4. Causes of Hyperthyroidism
Most common causes
Graves disease
Toxic multinodular
goiter
Autonomously
functioning nodule
Rarer causes
Thyroiditis or other causes
of destruction
Thyrotoxicosis factitia
Struma ovarii
Secondary causes (TSH or
ßHCG)

5. Hyperthyroidism Symptoms
Hyperactivity/ irritability.
Heat intolerance and sweating.
Palpitations.
Fatigue and weakness.
Weight loss with increase of appetite.
Diarrhoea.
Polyuria.
Oligomenorrhoea.
Loss of libido

6. Hyperthyroidism Signs
Tachycardia (AF)
Increased B.P
Tremor
Goiter
Warm moist skin
Proximal muscle
weakness
Lid retraction or lag
Gynaecomastia
Brisk tendon reflexes

7. Graves Disease
Autoimmune disorder
Ab directed against TSH receptor with intrinsic
activity. Thyroid and fibroblasts
Responsible for 60-80% of Thyrotoxicosis
More common in women

8. Graves Disease Eye Signs
N - no signs or symptoms
O – only signs (lid retraction or lag)
no symptoms
S – soft tissue involvement (peri-
orbital oedema)
P – proptosis (>22 mm)(Hertl’s test)
E – extra ocular muscle involvement
(diplopia)
C – corneal involvement (keratitis)
S – sight loss (compression of the
optic nerve)

9. Graves Disease Other
Manifestations
Pretibial myxedema
Thyroid acropachy
Onycholysis
Thyroid enlargement
with a bruit frequently
audible over the thyroid

10. Diagnosis of Graves Disease
TSH ↓, free T4 ↑
Thyroid auto antibodies
LATS,IF,Gastric parietal
cells.
Nuclear thyroid
scintigraphy (I131
, Tc99
)

11. Treatment of Graves Disease
Reduce thyroid hormone production or reduce
the amount of thyroid tissue
Antithyroid drugs: propylthiouracil, carbimazole
Radioactiveiodine
Subtotal thyroidectomy – relapse after antithyroid
therapy, young people.
Symptomatic treatment
Propranolol.

13. Hypothyroidism Symptoms
Tiredness and weakness
Dry skin
Feeling cold
Hair loss
Difficulty in
concentrating and poor
memory
Constipation
Weight gain with poor
appetite
Hoarse voice
Menorrhagia, later oligo
and amenorrhoea
Paresthesias

14. Hypothyroidism Signs
Dry skin, cold extremities
Yellow tint
Puffy face, hands and feet
Delayed tendon reflex relaxation
Carpal tunnel syndrome
Bradycardia
Increased B.P
Diffuse alopecia
Serous cavity effusions

15. Causes of Hypothyroidism
Autoimmune
hypothyroidism
(Hashimoto’s, atrophic
thyroiditis)
Iatrogenic (I123
treatment,
thyroidectomy, external
irradiation of the neck)
Drugs: lithium,
antithyroid drugs, etc
Iodine deficiency
Infiltrative disorders of
the thyroid:
amyloidosis, sarcoidosis,
haemochromatosis.

16. Lab Investigations of
Hypothyroidism
TSH ↑, free T4 ↓
Ultrasound of thyroid – little value
Thyroid scintigraphy – little value
Anti thyroid antibodies – anti-TPO
Sr.CK ↑, Sr.Chol ↑, Sr,Triglyseride ↑
Normochromic or macrocytic anemia
ECG: Bradycardia with small QRS complexes

17. Treatment of Hypothyroidism
Levothyroxine
If no residual thyroid function 1.5 μg/kg/day
Patients under age 60, without cardiac disease can be
started on 50 – 100 μg/day. Dose adjusted according to
TSH levels
In elderly especially those with CAD the starting dose
should be much less (12.5 – 25 μg/day)

19. Thyroiditis
Acute: rare and due to suppurative infection of the
thyroid
Sub acute:also termed de Quervins thyroiditis/
granulomatous thyroiditis – mostly viral origin
Chronic thyroiditis: mostly autoimmune
(Hashimoto’s)

20. Acute Thyroiditis
Bacterial – Staph, Strep
Fungal – Aspergillus, Candida, Histoplasma,
Pneumocystis
Radiation thyroiditis
Amiodarone (acute/ sub acute)
Painful thyroid, ESR usually elevated, thyroid function
normal

21. Sub Acute Thyroiditis
Viral (granulomatous) – Mumps, coxsackie, influenza,
adeno and echoviruses
Mostly affects middle aged women, painful enlarged
thyroid, usually complete resolution
Rx: NSAIDS and glucocorticoids if necessary

22. Sub Acute Thyroiditis
Silent thyroiditis
No tenderness of thyroid
Occur mostly 3 – 6 months after pregnancy
3 phases: hyper⇒hypo⇒resolution, last 12 to 20 weeks
ESR normal, TPO Ab present
Usually no treatment necessary

23. Chronic Thyroiditis
Hashimoto’s
Autoimmune
Initially goiter later very little thyroid tissue
Rarely associated with pain
Insidious onset and progression
Most common cause of hypothyroidism
TPO ab present (90 – 95%)

24. Chronic Thyroiditis
Reidel’s
Rare
Middle aged women
Insidious painless
Symptoms due to compression
Dense fibrosis develop
Usually no thyroid function impairment

25. Thyroiditis
The most common form of thyroiditis is Hashimoto
thyroiditis, this is also the most common cause of
long term hypothyroidism
The outcome of all other types of thyroiditis is good
with eventual return to normal thyroid function

27. CRETINISM
Imbecility.
Idiocy.